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Calendar Year 2020 Medicare Physician Fee Schedule Proposed Rule: What You Need to Know

Published on September 13, 2019

There are a few key points which could affect anesthesia practices, some of them significantly, in the coming year.  The anesthesia conversion factor and RBRVS conversion factors are ever so slightly increased, new pain codes are approved for use, the work RVUs on somatic nerve injections are decreased and there are several changes to the MIPS program.  Rather than read the entire 1,700 plus page rule, we have summarized these changes for you here.

Conversion Factors

The anesthesia conversion factor has increased from 2019’s $22.2730 to $22.2774 in 2020, and the RBRVS conversion factor, with a slightly better increase, is proposed to be raised from $36.0391 to $36.0896.  The anesthesia conversion factor affects the allowed amount per unit, while RBRVS affect the amount per RVU for CPT codes (i.e., chronic and acute pain procedures).  

New Chronic Pain Codes

The CPT Editorial Panel has created four new codes which the proposed rule accepts.  There are two codes for treatment of the genicular nerves (a nerve block and a nerve destruction code) and two codes for treatment of the nerves innervating the sacroiliac joint (a nerve block and a nerve destruction code).  This is good news for those practitioners who perform these procedures, as the new codes will have a higher RVU/reimbursement than the non-specific other peripheral nerve codes currently being used.

Somatic Nerve Codes RVUs Decreased  

The bad news is that reimbursement for several of the codes in the somatic nerves code set are being reduced.  The RUC (RVS Update Committee) suggested many of the decreases, and on several, Medicare proposed further decreases.  We recommend that all anesthesia providers comment on the negative impact this change will have on their practices by the comment deadline on September 27th.  Use the following link or paste it in your browser to view the proposed rule and comment. 

https://www.federalregister.gov/documents/2019/08/14/2019-16041/medicare-program-cy-2020-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other

Changes to MIPS

There have been changes to the performance thresholds for reporting period 2020.  Quality measures will require a threshold of 70% of patient population instead of 60%.  The total MIPS points threshold will increase from 30 to 45.  The penalty for failure to meet the threshold increases from 7% in 2019 to 9% in 2020.  MIPS total points percentages will be allocated as follows: Quality 40%, Cost 20%, Promoting Interoperability 25% and Improvement Activities 15%. 

As always, the complexity of billing and managing an anesthesia practice in today’s constantly changing healthcare arena can be quite overwhelming, but with a dedicated team of professionals by your side, you can navigate the sea of change successfully.

 

By Heather E. Golfos, CPC, CANPC

Coding Department Manager